Study: Houston among cities feeling health care pinch

Published 5:30 am, Sunday, June 29, 2008

Houston is one of a number of U.S. cities increasingly burdened by the federal government's failure to tackle the nation's health care problems, according to a new report.

Struggling to provide services to their uninsured and underinsured residents, mayors and leading health officials in 13 cities across the country want major health care reform to be a priority of the next president, the report found.

"No city, including Houston, can reform a national health care system," Houston Mayor Bill White said last week after the report was released. "Both doctors and patients know the system's broken, when so many people don't have access to care. That needs to change."

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White stopped short of calling for universal health care, saying he would defer to federal officials on specific techniques to alleviate the problems. But he added that "too often in the past, health care policy has been set by the pharmaceutical and insurance industries." He called on officials to give a greater voice to practicing physicians.

The report, "America's Health-Care Crisis: Cities on the Front Lines," was issued by Families USA, a liberal-leaning consumer organization that advocates affordable, high-quality health care for all Americans. It surveyed Houston and 12 other cities about the strain they feel in providing health care services to their most vulnerable residents.

Texas has most uninsured

Nearly 47 million Americans currently lack insurance, and 61.6 million people are considered underinsured — members of families that will spend more than 10 percent of their pre-tax income on health care in 2008, according to Families USA.

Texas has the highest percentage of uninsured among the states, with one in four people lacking coverage, according to the U.S. Census. Houston has the largest share of uninsured among the state's metro areas — 1.1 million, or more than 30 percent of its residents.

That burden showed in the survey.

Houston consistently finished among the most strained cities, reporting hospital and emergency department crowding and increased demand at safety-net clinics, mental-health, substance-abuse and family-support service providers. It was not among the cities reporting hospital closings, because last week's closing of River Oaks Hospital's two campuses came too late for the survey.

"We also see the strain in the severity level of patients admitted to our hospitals," said King Hillier, vice president of public policy and government relations for the Harris County Hospital District, which provides most of the Houston area's safety-net care. "Because they aren't getting primary care sooner, more and more are showing up sicker."

According to the latest district statistics, the percentage of patients being admitted with more complicated illnesses and requiring a higher level of care has risen 34 percent since 2005.

Families USA didn't survey the district, but Hillier said he concurred with everything in the report. He said a more realistic hope than comprehensive health care reform is incremental reform, specifically an expansion of Medicaid coverage and the Children's Health Insurance Program, which are funded by both the federal and state governments. Hillier and White said Texas and the federal government need to better fund the two programs.

White also said the Texas Insurance Commission needs to put on its agenda greater regulation of the insurance plans offered by employers. Calling for the commission to encourage a full range of affordable plans, he said too many employers now give a choice of "a Cadillac or walking."

Struggle across the board

The Families USA survey reported that amid rising health care costs, all 13 surveyed cities are struggling to provide health coverage to municipal employees. It said some of the cities are considering cuts in emergency and quality-of-life services for residents.

Among the other findings:

•Houston and 10 other cities reported the demand for health services has increased over the past year.
•Houston and five other cities reported that they're "very strained" trying to meet the demand.
•Houston and five other cities reported half of their emergency departments were operating above capacity. During the first six months of 2006, Houston's major emergency departments were on "drive by" (wherein ambulances are diverted elsewhere because of overcrowding) 40 percent of the time.
•Houston reported that the most serious gaps in its safety net affect childless adults, parents and children, in that order.
The other cities participating in the survey were Albuquerque, N.M.; Boston; Charleston, S.C.; Columbus, Ohio; Minneapolis; Newark, N.J.; Oakland, Calif.; Providence, R.I.; San Francisco; Seattle; Tucson, Ariz.; and Washington.

In 2006, San Francisco became the first city to create its own universal health access program for the uninsured. Employers with more than 20 employees must meet a minimum spending requirement for health care coverage for their employees or pay into the plan, which is open to any resident who has been uninsured for 90 days and ineligible for public coverage such as Medicaid.